基于“使道”学说探讨冠心病伴抑郁的防治  

Treatment of Coronary Heart Disease with Depression Based on the Theory of“the Pathways of Spirit”

作　　者：楼雅荟 钱袁媛 王俨杰 朱爱松 LOU Yahui;QIAN Yuanyuan;WANG Yanjie(Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome,Hangzhou(310053),China;Zhejiang Engineering Research Center for“Preventive Treatment”Smart Health of Traditional Chinese Medicine;School of Basic Medical Sciences,Zhejiang Chinese Medical University)

机构地区：[1]浙江省中医“瘀毒”证重点实验室,杭州310053 [2]中医“治未病”智慧健康浙江省工程研究中心 [3]浙江中医药大学基础医学院

出　　处：《浙江中医药大学学报》2025年第3期272-278,共7页Journal of Zhejiang Chinese Medical University

基　　金：浙江省“尖兵领雁”攻关项目(2024C03192);国家自然科学基金项目(82474362);国家中医药管理局科技司-浙江省中医药管理局共建科技计划项目(GZY-ZJ-KJ-24011)。

摘　　要：[目的]基于“使道”学说探讨冠心病伴抑郁的因机证治。[方法]分析神使乏源、使道不利、心神不使三者与冠心病伴抑郁的关系,总结冠心病伴抑郁各阶段的证治规律。[结果]冠心病伴抑郁的演变过程以气血亏虚、神使乏源为发病之基,此阶段治当补益气血,宜选用归脾汤、桂枝龙骨牡蛎汤、既济汤等方化裁;瘀毒互结、使道不利为冠心病伴抑郁的发病之本,此阶段治宜选用血府逐瘀汤或四妙勇安汤等方化裁以化瘀解毒,同时重用黄芪等药扶正而不留邪;气机郁滞、心神不使为疾病恶化之要,在气机郁滞明显阶段,活用柴胡剂、越鞠丸等方化裁以行气解郁,针药结合,既病防变。[结论]使道是心神往来之道,是心与其他脏腑沟通协调之道。神使乏源、使道不利、心神不使是冠心病伴抑郁发生发展的重要病机,立足于“使道”学说,有助于认识冠心病伴抑郁的疾病演变过程,完善冠心病伴抑郁的分阶段证治法则及具体方药。[ObjectiveObjective]To explore the etiology,pathogenesis,syndrome and treatment of coronary heart disease with depression based on the theory of“the pathways of spirit”.[MethodsMethods]Starting from the theory of“the pathways of spirit”,the relationships among insufficient control of spirit,obstructed the pathways of spirit and impaired heart-spirit functioning in coronary heart disease with depression were analyzed,and the treatment principles at different stages were summarized.[ResultsResults]The evolution of coronary heart disease with depression is based on the deficiency of Qi and blood and the insufficient control of spirit.At this stage,Guipi Decoction,Guizhi Longgu Muli Decoction and Jiji Decoction should be used to supplement Qi and blood.The root cause of coronary heart disease with depression is the combination of blood stasis and toxin,which leads to the obstruction of the pathways of spirit.At this stage,Xuefu Zhuyu Decoction or Simiao Yong’an Decoction should be used to dissipate blood stasis and detoxing,combined with large dosage of Astragalus membranaceus to strengthen the healthy Qi without retaining pathogens.The important reason for the deterioration of coronary heart disease with depression is stagnation of Qi which causes impaired heart-spirit functioning.At the obvious stage of Qi stagnation,modified prescriptions such as Bupleurum based formulas and Yueju Pill should be flexibly applied to promote Qi circulation and relieve depression,combined with acupuncture in order to prevent the deterioration of the disease.[ConclusionConclusion]“The pathways of spirit”is the way of heart spirit interaction,and communication and coordination between the heart and other organs.Insufficient control of spirit,obstructed pathways of spirit,and impaired heart-spirit functioning are important pathogenesis for the occurrence and development of coronary heart disease with depression.Based on the theory of“the pathways of spirit”,it helps to understand the disease evolution process of corona

关 键 词：冠心病 抑郁 治未病 使道 神使乏源 使道不利 心神不使 针药结合 

分 类 号：R732[医药卫生—肿瘤]